A New You (Brighton) Limited

This service is rated as Inadequate overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Good

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at A New You (Brighton) Ltd on 5 July 2021 under Section 60 of the Health and Social Care Act 2008. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. This was the provider’s first inspection of the service since it registered with the Care Quality Commission (CQC).

Throughout the COVID-19 pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Speaking with staff in person and using video conferencing.
• Requesting documentary evidence from the provider.
• A site visit.

We carried out an announced site visit to the service on 5 July 2021. Prior to our visit we requested documentary evidence electronically from the provider. We spoke to staff using video conferencing following our site visit, between 6 and 12 July 2021.

A New You (Brighton) Ltd is an independent provider of consultations and treatment for dermatological conditions, including acne and rosacea, prescription skincare, and mole removal and screening. Botox (Botulinum toxin) injections are provided for the treatment of excessive sweating. The service also provides pre- and post-operative consultations for surgical cosmetic treatments and follow up care post-surgery. Surgery is carried out at other locations that are independent of this service.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A New You (Brighton) Ltd also provides a wide range of non-surgical aesthetic interventions. This included cosmetic Botox injections, dermal fillers and facial thread vein treatments, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

A New You (Brighton) Ltd is registered with the Care Quality Commission to provide the following regulated activities: Treatment of disease, disorder or injury; Diagnostic and screening procedures. Prior to our inspection we identified that the provider was carrying out the excision of moles and other skin lesions without being registered to provide the required regulated activity Surgical procedures. Immediately prior to our site visit, the provider submitted an application to provide Surgical procedures as a regulated activity.

The service director is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• There was a lack of monitoring of training undertaken by staff and those employed on a sessional basis. There was a lack of training for staff in some key areas.
• There was a lack of performance review, clinical supervision and monitoring of clinical staff employed on a sessional basis. Staff employed by the service had not recently undergone appraisal.
• Systems for the safe and appropriate use of medicines were not in place. Medicines requiring refrigeration were not stored or monitored to ensure they remained safe and effective.
• Prescribing practices were not adequately monitored to identify risks to patients. There was a lack of auditing of clinical and prescribing processes.
• There was a lack of effective systems and processes to assess the risk of, and prevent, detect and control the spread of infections. This included processes to maintain and monitor staff vaccination.
• There was a lack of safeguarding systems and processes to keep people safe. Some staff had not received training in the safeguarding of adults or children.
• Arrangements for chaperoning were not effectively managed. Staff had not received chaperone training and had not been subject to Disclosure and Barring Scheme (DBS) checks.
• Although there were suitable emergency medicines in place, arrangements to manage medical emergencies had not been risk assessed.
• Patient safety alerts had not been received or monitored by the service.
• Fire safety processes were in place. Staff had participated in fire drills and had received fire safety training.
• There were general health and safety risk assessments in place.
• There was a lack of governance and monitoring processes to provide assurance to leaders that systems were operating as intended.
• Best practice guidance was not always followed in providing treatment to patients. For example, in the assessment and removal of lesions and weight management prescribing requirements.
• There was an inconsistent approach to clinical record keeping and a lack of information governance processes. Key records and documents were missing for some patients.
• There were no records to demonstrate that recruitment checks had been carried out in accordance with regulations, including for clinical staff employed on a sessional basis.
• Policies and procedures were not monitored, reviewed and kept up to date. Policies failed to provide relevant and sufficient information.
• Staff found leaders approachable and supportive and felt they provided an individual service to patients.
• Staff dealt with patients with kindness and respect.
• Patients were routinely asked to provide feedback on the service they had received. Complaints were managed appropriately.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

We took enforcement action against the provider in relation to Regulation 12(1) Safe care and treatment and Regulation 17(1) Good governance. We issued a Notice of Proposal under Section 18 of the Health and Social Care Act 2008 to suspend the provider’s registration. The provider submitted written representations to us which were not upheld. We issued a Notice of Decision under Section 18 of the Health and Social Care Act 2008 to suspend the provider’s registration as a provider, in respect of all regulated activities, for a period of three months. This notice to suspend the provider’s registration was issued because we believed that a person will or may be exposed to a risk of harm if we did not take this action. The provider had the right to make an appeal to the First-tier Tribunal. The period of suspension became effective on 18 November 2021. The provider will be inspected again prior to the expiry of the suspension to assess whether sufficient improvements have been made.

We also issued a Requirement notice in relation to Regulation 18(1)(2) Staffing.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Develop the service’s complaints policy to include information to support patients should their complaint remain unresolved.

I am placing this service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care